​General Directorate of Infection Prevention and Control

Surveillance Unit

General Directorate of Infection Prevention and Control

​​​​الإدارة العامة لمكافحة عدوى المنشآت الصحية

DEFINITION:

Surveillance is an essential component of an effective infection prevention and control (IPC) program. is a systematic method of ongoing data collection, analysis, and interpretation  which is related to the distribution and determinates of a given disease or event, to improve the outcome.


OBJECTIVES:

  • To measure the incidence of HAIs and the organisms that cause these infections and establish their endemic rates using standard CDC 2016 definitions and methods

  • To measure utilization ratio of invasive devices .
  • To benchmark HAIs rates and utilization ratios at the local, regional, and international levels
  • To detect and control hospital clusters or outbreaks of HAIs and MDROs.
  • To maintain a comprehensive data system to monitor, evaluate, and implement necessary actions to ensure a safe and healthy environment for patients, personnel, and visitors
  • To monitor antimicrobial susceptibilities and the development of new resistant microbial strains that may pose as a challenge to the healthcare system


ESSENTIAL ELEMENTS OF SURVEILLANCE:

A.    the population identified those at greatest risk for the outcome or process 

  1. Healthcare-associated infections (HAIs) (outcomes)
  2. Patient care practices bundles aimed to prevent HAIs (processes)

B.    Select the appropriate outcome or process to be monitored by surveillance

  1. CLABSI ,CAUTI,VAP,SSI   as outcome
  2. CLABSI bundle ,VAP bundle CAUTI bundle and SSI bundles 

C.    Observation time period: data collection continuous process ,but rates and trends should be analyzed monthly at the hospital and directorate level ,quarterly at MOH level  
D.    Use active patient based prospective targeted surveillance methodology
E.    Monitor the outcome or process using standardized CDC 2016 definitions for HAIs
F.    Collect appropriate denominator data 
G.    Analyze surveillance data using electronic or manual system.
H.    Report and use surveillance information in a timely manner


SURVEILLANCE INDICATORS:

  1. Device-Associated Module
    •    Central Line-Associated Bloodstream Infection (CLABSI) Event
    •    Ventilator-Associated Pneumonia (VAP) Event
    •    Catheter-Associated Urinary Tract Infection (CAUTI) Event
  2. Procedure-Associated Module
    ​•    Surgical Site Infection (SSI) Event
  3. Dialysis Event (DE)
  4. Infection Surveillance Reporting
  5. Bundles
    •    Central Line bundle
    •    Ventilator bundle
    •    Urinary catheter bundle
    •    Surgical bundle

SURVEILLANCE METHODOLOGY:

  • surveillance modules require active, patient-based, prospective, priority-directed surveillance of device/medication/procedure- associated infection events and their corresponding denominator data by a trained infection control professional (ICP).
  • ICP shall seek out infections during a patient’s stay by screening a variety of data sources.
  • Retrospective chart reviews should be used only when patients are discharged before all of the information could be gathered.
  • Other HCWs (other than ICPs) may be trained to screen data sources for these infections, but the ICP must make the final determination.
  • To minimize the ICP’s data collection burden, others may be trained to collect the denominator data (separate forms for device/medication-associated infections).


OUTCOME 
CALCULATING RATES:

CLABSI: The CLABSI rate per 1,000 central line-days is calculated by dividing the number of CLABSI by the number of central line-days and multiplying the result by 1,000. The Central Line Utilization Ratio is calculated by dividing the number of central line-days by the number of patient-days. These calculations will be performed separately for different types of ICUs, specialty care areas, and other locations in the institution. Separate rates and ratios will also be calculated for different types of catheters and birth weight categories in NICUs.
 
VAP: The VAP rate per 1,000 ventilator-days is calculated by dividing the number of VAPs by the number of ventilator-days and multiplying the result by 1,000. The Ventilator Utilization Ratio is calculated by dividing the number of ventilator-days by the number of patient-days. These calculations will be performed separately for the different types of ICUs, specialty care areas, and other locations in the institution, as well as by each birth weight category in NICUs.

CAUTI: The CAUTI rate per 1,000 urinary catheter-days is calculated by dividing the number of CAUTIs by the number of catheter-days and multiplying the result by 1,000. The Urinary Catheter Utilization Ratio is calculated by dividing the number of urinary catheter- days by the number of patient-days. These calculations will be performed separately for the different types of ICUs, specialty care areas, and other locations in the institution.

DE: The numbers of various events (redness, hotness, in-unit IV antimicrobial start, or positive blood culture) are tabulated, and the rates of these events per 100 patient- months are calculated by dividing the number of events by the number of patient-months and multiplying the result by 100. These rates are stratified by vascular access type and compared with the mean rate of all of the centers combined.

SSI: The SSI rates per 100 operative procedures are calculated by dividing the number of SSIs by the number of specific operative procedures and multiplying the results by 100. These calculations will be performed separately for different types of operative procedures and stratified by risk index.
MDRO Infection Surveillance: The MDRO infection incidence rate is calculated by dividing the number of infections of a certain MDRO type by the number of patient-days and multiplying the results by 1,000. The rate is then stratified by time (e.g. Quarter, annual ) and patient care location.